Healthcare Provider Details

I. General information

NPI: 1710071873
Provider Name (Legal Business Name): ELBERTA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24980 STATE ST
ELBERTA AL
36530-0670
US

IV. Provider business mailing address

PO DRAWER 670
ELBERTA AL
36530-0670
US

V. Phone/Fax

Practice location:
  • Phone: 251-986-8115
  • Fax: 251-986-3062
Mailing address:
  • Phone: 251-986-8115
  • Fax: 251-986-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateAL

VIII. Authorized Official

Name: TONJA MARIE LOWERY
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 251-986-8115